Sacko Oumar, Boetto Sergio, Lauwers-Cances Valérie, Dupuy Martin, Roux Franck-Emmanuel
Service de Neurochirurgie, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France.
J Neurosurg Pediatr. 2010 Jan;5(1):68-74. doi: 10.3171/2009.8.PEDS08108.
Although endoscopic third ventriculostomy (ETV) has been accepted as a procedure of choice for the treatment of obstructive hydrocephalus, the outcome of this treatment remains controversial with regard to age, cause, and long-term follow-up results. The goal of this study was to assess the risk of failure associated with these factors in a retrospective cohort study.
Between 1999 and 2007, 368 ETVs were performed in 350 patients (165 patients < 18 years of age) with hydrocephalus at the University Hospital of Toulouse. Failure of ETV was defined as cases requiring any subsequent surgical procedure for CSF diversion or death related to hydrocephalus management.
Tumors (53%), primary aqueductal stenosis (18%), and intracranial hemorrhage (13%) were the most common causes of hydrocephalus. The median follow-up period was 47 months (range 6-106 months), and the overall success rate was 68.5% (252 of the 368 procedures). Patients < 6 months of age had a 5-fold increased risk of ETV failure than older patients (adjusted hazard ratio [HRa] 5.0; 95% CI 2.4-10.4; p < 0.001). Hemorrhage-related (HRa 4.0; 95% CI 1.9-8.5; p < 0.001) and idiopathic chronic hydrocephalus (HRa 6.3, 95% CI 2.5-15.0, p < 0.001) had a higher risk of failure than other causes. Most failures (97%) occurred within 2 months of the initial procedure. The overall morbidity rate was 10%, although most complications were minor. Finally, the introduction of ETV in the authors' department reduced the number of shunt insertions and hospital admissions for shunt failures by half and was a source of cost savings.
Endoscopic third ventriculostomy is a safe procedure and an effective treatment option for hydrocephalus. Factors indicating potential poor ETV outcome seem to be very young children and hemorrhage-related and chronic hydrocephalus in adults.
尽管内镜下第三脑室造瘘术（ETV）已被公认为治疗梗阻性脑积水的首选方法，但该治疗方法在年龄、病因及长期随访结果方面的疗效仍存在争议。本研究的目的是在一项回顾性队列研究中评估与这些因素相关的治疗失败风险。
1999年至2007年间，图卢兹大学医院对350例脑积水患者（165例年龄小于18岁）实施了368例ETV手术。ETV治疗失败定义为需要后续进行任何脑脊液分流手术的病例或因脑积水治疗相关的死亡。
肿瘤（53%）、原发性导水管狭窄（18%）和颅内出血（13%）是脑积水最常见的病因。中位随访期为47个月（范围6 - 106个月），总体成功率为68.5%（368例手术中的252例）。6个月以下的患者ETV治疗失败的风险比年龄较大的患者高5倍（调整后的风险比[HRa] 5.0；95%可信区间2.4 - 10.4；p < 0.001）。与出血相关的脑积水（HRa 4.0；95%可信区间1.9 - 8.5；p < 0.001）和特发性慢性脑积水（HRa 6.3，95%可信区间2.5 - 15.0，p < 0.001）治疗失败的风险高于其他病因。大多数治疗失败（97%）发生在初次手术后2个月内。总体发病率为10%，尽管大多数并发症较轻微。最后，作者所在科室引入ETV后，分流管植入数量和因分流管故障导致的住院次数减少了一半，并节省了成本。
内镜下第三脑室造瘘术是一种安全的手术，是治疗脑积水的有效选择。提示ETV疗效可能不佳的因素似乎是幼儿以及成人中与出血相关的脑积水和慢性脑积水。
